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Can a Shrub in Gabon Cure Addiction?

The United States is struggling with a staggering opioid addiction epidemic—often starting with legitimate pain pill prescriptions, and ending with full-blown abuse. It is estimated that there are four million people in America who are addicted to pain medicines or heroin, with a growing number overdosing from a surge in fentanyl-spiked pills from drug traffickers in Mexico. It is devastating and debilitating families, compounded by the fact that recovery rates via standard, rehab-based treatment options are not that promising—though replacement drugs like methadone and suboxone can help.

But there is a tree in Gabon that might change this. Ibogaine, brought forward in the Western world by a drug addict, Howard Lotsof, in the ‘60s, is a hallucinogenic (or oneiric, i.e. dream-inducing) agent that acts not only as an addiction interrupter, but also, purportedly, like a mystical therapist—offering a “journey” through triggering traumas during one, very intense, 24-hour trip. Not only does it plug dopamine receptors—meaning patients emerge craving-free—but it is said to provide a massive cathartic release and life-review. Post-treatment, it is believed that addicts have a good three months to impose healthy routines (regular exercise and good diet are imperative for recovery), change triggering behaviors (move neighborhoods or cities, leave toxic relationships), and establish ongoing therapy without also struggling with withdrawal symptoms and insatiable cravings.

Here’s the rub: Ibogaine is a Schedule I drug in the United States, which means that it has no official medicinal value. It is legal in Mexico and Canada, and other countries around the world, but without big pharma stepping in to fund clinical trials, it has no chance of becoming a viable protocol in the US. Dr. Deborah Mash, a professor of neurology and pharmacology at the Miller School of Medicine at the University of Miami has been working with ibogaine since 1992 and, convinced of its value, has explored every avenue for getting it approved. Below, she explains more.

A Q&A with Deborah Mash, Ph.D.

Q

Can you explain what ibogaine is? How does it work as an addiction disruptor? And as a hallucinogen, how does it work on both a physical and emotional/spiritual level?

A

Ibogaine’s ability to alter drug-taking behavior may be caused by the combined actions of either the parent drug and/or its active metabolite at key pharmacological targets that modulate the addiction circuit in brain. Ibogaine is an indole alkaloid from mother nature that gets converted to an active metabolite, noribogaine. The metabolite targets specific neurotransmitters in the brain—opioid, serotonin, and acetylcholine—blocking withdrawal and cravings and alleviating depression.

In other words: Ibogaine effectively blocks the acute signs of opiate withdrawal—the extreme anxiety, fever, chills, muscle cramps, nausea, and vomiting—but it also diminishes post-acute withdrawal syndrome. Addicts in early recovery report intense cravings, lack of energy, depression, “I feel rotten” for weeks to months after they stop using their drugs. When I was administering ibogaine to patients in St. Kitts [more on this below], we noted depression scores plummeted (in a good way), anxiety went down, energy levels were higher, and patients could start to think clearly. They were able to formulate a plan to maintain a clean life and to make that transition to sobriety.

Ibogaine’s effects on glutamate and NMDA receptors in the brain accounts for the psychotropic effects and the “dream-like” experience.

Q

What is a typical experience?

A

Shortly after ibogaine administration, most people have an active period of visualizations that are described as a “waking dream state,” followed by an intense cognitive phase of “deep introspection.”

Q

Who is the treatment most effective for—does it work on all types of addicts?

A

The treatment is most effective for people addicted to heroin and prescription opioids, but cocaine and alcohol abusers also report benefits. (Much less is known about the benefit of ibogaine for methamphetamine abusers.)

Q

What’s the success rate? And how does that relate to more traditional rehab success rates?

A

Ibogaine is highly effective (about 90 percent) for blocking the signs and symptoms of opioid withdrawal. Most people report that their cravings and desire to use is diminished. Ibogaine is an addiction interruptor, not a “cure.” The estimated success rates for traditional rehabilitation (30- to 90-day programs) is about twenty percent at one year. We observed about a fifty percent success rate for patients after one year, but more studies are needed.

(Note: Since the ibogaine program is only seven days given as a detoxification, it can not be compared to any other programs. Studies would need to be done for people in treatment compared to patients treated with ibogaine and then matched to the same program.)

Q

How did you get involved with ibogaine research?

A

I’ve been funded by the National Institute of Drug Abuse (NIDA) for almost twenty-seven years to study the effect of drugs on the brain and behavior. When I first heard about ibogaine as an addiction interrupter, I recognized that it might be something that could provide a tremendous benefit for people suffering from addiction. Since seeing is believing, I got on a plane with a medical doctor colleague and flew to Amsterdam, where I saw an underground railroad of addicts helping other addicts by administering ibogaine.

I presented ibogaine to the FDA back in 1992—we were given the first permission here in the United States to test ibogaine in a phase I protocol with human volunteers at the University of Miami School of Medicine.

Q

How does one get something like that through the FDA?

A

Howard Lotsof—an addict who actually discovered ibogaine when he took a dose himself and it curbed his withdrawal and cravings—had five use patents issued for ibogaine in the treatment of drug and alcohol dependencies. Ibogaine is a Schedule I drug, which officially means that it has no medical value. It’s very difficult to do the required phases of clinical trials, as getting a drug through the FDA costs hundreds of millions of dollars.

We signed an agreement with Lotsof to obtain the drug, so that we could begin testing it “above ground,” in an established academic medical school. My goal was to get credentialed doctors, psychologists, and addiction specialists to look at the risks and benefits of ibogaine, to determine whether or not it worked as he had suggested.

“Unfortunately, you simply cannot get a medicine approved for use in the United States without real dollars needed to support drug development.”

The short and the long story behind what stalled ibogaine is that Lotsof had no money to fund the clinical trials. Without FDA clinical trials, there could be no approval or advancement. Because he held the intellectual property and we didn’t, he needed to fund the research, but this never happened. It was left to me to go out and get federal dollars to bankroll the clinical research studies. Although I tried very hard, I was not successful in doing this. So after extensive grant writing and working with the National Institute of Drug Abuse, I decided my best chance to learn about this drug was to go offshore. I got permission from the government of St. Kitts and Nevis in the West Indies, and we set up a research facility to test ibogaine in patients.

People came from all over the world, and we also opened the doors to visiting doctors, scientists, and clinicians. After running years of studies there, I presented the information to my colleagues and peers—and also to the FDA. After ten years of work, we closed down the R&D facility and returned home to work toward an approval path for the active metabolite of ibogaine.

In 2010, I began to raise money for a company called DemeRx, Inc., to fund clinical research studies of noribogaine—the metabolite of ibogaine. Because ibogaine is converted to noribogaine through the liver, we reasoned that it might be possible to dissociate the anti-craving, anti-addiction effects of ibogaine from the hallucinogen or “journey” of the drug experience. We believed that the pharmaceutical industry would be more interested in joining us and funding a drug development venture if we could create new intellectual property. Since there was never any philanthropic interest that could make this project advance, a partnership with pharma was the only road forward. Unfortunately, you simply cannot get a medicine approved for use in the United States without real dollars needed to support drug development.

Q

Considering the epidemic in this country, is there any chance that the FDA can help expedite?

A

The FDA has been great when it comes to the evaluation of ibogaine and its metabolite, noribogaine—and they have all my original clinical data. I’ve been in front of them four times. They know that the data has value since they originally approved the studies, and the review doctors and scientists who work at the FDA are well-meaning people who want to help us out of the prescription drug epidemic. But the bottom line is that they have to “check the box”: You have to go through the various phases of the clinical trials, and that costs an enormous amount of money. If there isn’t a financial exit, then nobody is going to fund the clinical trial research that the FDA requires for approval. The pharmaceutical industry develops all the drugs that become medicines, and if they’re not interested, it’s not going to happen. That said, we do have the medical marijuana movement—nobody took medical marijuana through the FDA.

“The pharmaceutical industry develops all the drugs that become medicines, and if they’re not interested, it’s not going to happen.”

The FDA needs to be assured that ibogaine can be given safely, under proper medical supervision. They know that there are candidates who may benefit, while other patients may not. We might need to do this on a patient-by-patient basis under a compassionate-use protocol. You can imagine that doctors may petition the FDA in the first year for twenty people; the next year doctors put up 2,000 requests; the next year it’s up to 20,000 requests. With that amount of interest and success, the community of treatment professionals will join the rank and file.

Q

Why isn’t big pharma taking a closer look?

A

Pharmaceutical companies have really shied away from developing drugs for the treatment of addiction. Addiction is a very complex disorder, as many drug addicts are effectively self-medicating, whether it’s for generalized anxiety or major depression, PTSD, etc. There are many other psychiatric disorders and early childhood experiences and traumas that contribute to the underlying problem. From a clinical trial standpoint, it’s really difficult to design a study that controls for these factors.

Addiction is also a chronic relapsing disorder—anyone who says otherwise is making a false statement. While it always makes my heart dance when I hear of someone who took a single dose of ibogaine and never used heroin or cocaine again, most people will require a booster dose or re-treatment somewhere down the road. Stress, boredom, and disappointment are all a normal part of life, but often the triggers for relapse. I mean, when you think about it, ten years of hardcore abuse is not likely to be reversed with a single dose of any medicine. You need to have a program to stay sober and out of harm’s way.

“It is a slam-dunk for opiates, as it is a very gentle opiate detox from the withdrawal, and also helps stave off the return of drug cravings and rapidly improves mood.”

But don’t forget that ibogaine gets converted to an active metabolite, which stays in the body for weeks to a month, which really helps people get through the early phase of drug or alcohol detoxification. If you’ve ever seen anyone in early detox, they feel terrible. Their mind is racing and they can’t stop thinking about getting high. I will continue to state on the record: If you can couple ibogaine with substance abuse treatment, I believe wholeheartedly that recovery rates will really increase. It is a slam-dunk for opiates, as it is a very gentle opiate detox from the withdrawal, and also helps stave off the return of drug cravings and rapidly improves mood.

Q

Where are you at with ibogaine now?

A

I’ve spent a lot of my life advancing this cause: from getting the first FDA approval, starting companies to test the molecule, and then of course, conducting actual treatments under medical supervision. I have the largest clinical database of anyone in the world on the use of ibogaine for the treatment of addiction.

But unfortunately, today, ibogaine has pretty much gone to the underground of self-styled ibogaine practitioners. There are many people all over the world—some well meaning, some not well-meaning—who operate ibogaine treatment centers and put addicts in harm’s way.

There have been deaths. If you don’t have medical supervision, addicts can get into serious trouble, as people who abuse drugs and alcohol are often very sick and might have damaged livers or hearts. Because it’s processed through the liver, there are a lot of drug interactions. This isn’t a mushroom or ayahuasca trip. If you don’t know what a person providing the treatment actually knows about ibogaine or exactly what drug he or she is giving you, you are going to put yourself at risk for an adverse event. It’s terrible, because addicts are desperate to get help, and they are going to these underground clinics run by unskilled people without medical training or experience.

Q

What would you say to people looking into ibogaine clinics? Are there other options?

A

Currently, the standard of care is detoxification with methadone or buprenorphine, or entry to a three-day hospital detox program.

People seeking ibogaine need to request the credentials and experience of their treatment provider. Addicts are going to do ibogaine wherever they can get it, but I would say that it is “buyer beware.” Do your homework. Make sure that you’re working with a doctor who is a genuine doctor, ideally someone who has trained with me or worked with us in St. Kitts. You want to be sure that you’re really getting ibogaine (some people combine ibogaine with other drugs), and that you’re entrusting yourself to someone who has a lot of experience and is trained in emergency medicine or cardiology and certified in addiction medicine, who can safely administer ibogaine.

Q

How important is the psychedelic “journey,” or do you think that the metabolite of ibogaine is enough?

A

After twenty-five years of studying ibogaine, I’m still convinced that not only does the “journey” help people gain insight into destructive behaviors, but that it’s also very effective for curbing the compulsive desire and cravings for drugs, especially opiates.

I called the initial ibogaine dose a chemical Bar Mitzvah in an article in Omni Magazine over a decade ago. I stand by that: I think it is important to give a patient the ibogaine “journey” because it does help them develop insights into their self-destructive behaviors.

However, addiction is a brain disease, so the molecule needs to target this aspect. There are organic triggers for continuing to abuse drugs, psychological triggers, and social triggers—and for many people, it’s about finding the brain’s locus of control. In the twelve-step program, you give the control up to a higher power. My clients who did ibogaine under medical supervision said that it’s like doing the fourth step, where you complete a moral inventory. Instead of white-knuckling a detox, the “journey” helps you get over the hump. The body then makes noribogaine, which is the booster to get through the withdrawals. It’s an antidepressant and helps block cravings. The noribogaine stays in the brain for several weeks. If you give noribogaine to a rat, they will stop taking cocaine, stop taking alcohol, stop taking opioids, and stop taking nicotine. These studies help us understand why ibogaine is effective as an addiction interrupter.

My ideal would be to follow the ibogaine treatment with a noribogaine depot injection that lasts 30 days, or a patch, or a pill that you take once or twice a week to help addicts extend that window of addiction interruption to allow the brain chemistry to restore itself back to normal. If an addict feels like they’re going to relapse, they can go to their doctor and get the patch or pill to prevent the drug craving from returning, to help block the desire to get high.

Drugs lead you to bad places, and every addict is going to need some post-ibogaine therapy. But this treatment speeds up the therapeutic process and helps patients make that transition to long-term sobriety.

Q

It seems like a slam dunk: What can we all do to help advance the cause?

A

I have thought about this question for a very long time. I believe that we really need to create a citizen’s petition to move ibogaine from Schedule I to Schedule II. First, ibogaine is not a recreational drug of abuse. No one wants to take ibogaine to get high. Second, it would be incredible if physicians could use ibogaine in this country under a compassionate use protocol. That’s what I want to work toward. Drug addiction is a life-threatening disorder, and pharmaceutical companies are not stepping up to help by developing effective treatments.

Post-9/11, we’ve been overrun with cheap heroin entering our country. Prescription drug abuse is off the charts. Drug traffickers from Mexico are spiking heroin with fentanyl, causing many more opioid-related deaths. In China, people are synthesizing fentanyl analogs and these designer molecules are coming into the US through Mexico.

We can’t afford the opioid drug epidemic that we have today in America. Everyone is affected, from our health care system to employers, families, and children. Addicts need safe access to help them get off of the drugs—they have a right to have an ibogaine treatment, administered in a safe setting. People want the opportunity to get off drugs and to go back to being functioning, tax-paying citizens. They shouldn’t have to go to back-door, abortion-style clinics, desperate for a chance at recovery.

“People want the opportunity to get off drugs and to go back to being functioning, tax-paying citizens. They shouldn’t have to go to back-door, abortion-style clinics, desperate for a chance at recovery.”

A lot can be done with some seed money—a small group of well-meaning individuals could help us bring this before the right audience. This is something that I’m working toward right now.

The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of goop, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.

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